Biopsy Results Research Articles

Abstract 4119470: ST-Elevation Myocardial Infarction as a Complication of Granulomatosis with Polyangiitis

Description of Case: A 19-year-old female with history of granulomatosis with polyangiitis (GPA) presented to the emergency department after a syncopal episode at a concert. She reported a prodrome of feeling hot and dizzy prior to the event, followed by epigastric discomfort, nausea, and vomiting after regaining consciousness. She had been diagnosed with GPA one year prior to presentation based on serology and biopsy results. Because her disease was felt to be well-controlled on azathioprine, she had been tapered off of prednisone one month prior to presentation. Initial vitals included blood pressure of 90/60 mmHg, and heart rate of 94 bpm. A 12-lead EKG revealed ST segment elevation in leads I, II and aVF with T wave inversions in the lateral leads ( Figure 1 ). Initial bloodwork was notable for troponin I of 0.11ng/mL (upper limit of normal 0.034 ng/mL). A diagnosis of inferior ST-elevation myocardial infarction was made. She was treated with oral aspirin and prasugrel load as well as intravenous heparin and taken urgently to the catheterization laboratory. Diagnostic coronary angiography was significant for single vessel coronary artery disease (CAD) of the right coronary artery (RCA), with acute complete occlusion of the mid-RCA ( Figure 2A-B ). She was treated successfully with primary percutaneous coronary intervention and implant of two overlapping drug eluting stents in the mid-RCA ( Figure 2C ). Discussion: GPA is a systemic necrotizing vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA) that predominantly affects small to medium sized vessels in the respiratory tract and kidneys. Cardiovascular manifestations in GPA are uncommon, but include pericarditis, myocarditis, and coronary arteritis. GPA can affect the coronary arteries either primarily through inflammatory changes in the arterial wall or via systemic inflammation leading to accelerated atherosclerosis. No standardized criteria exist to establish the diagnosis of coronary arteritis and to differentiate it from accelerated atherosclerosis. Long-term treatment of vasculitis patients with coronary involvement is also poorly supported by evidence. Optimization of cardiovascular risk factors is advocated as per standard of care, and vasculitis control may slow disease progression. This case not only raises awareness of cardiac complications in GPA, but highlights the current lack of evidence surrounding secondary prevention in young patients with vasculitis and cardiac complications.

Abstract 4141448: Evaluation of cardiac amyloidosis with cardiac MRI and association with endomyocardial biopsy findings

Introduction: Late gadolinium enhancement (LGE) observed on cardiac magnetic resonance imaging (CMR) has emerged as a potential indicator of myocardial involvement in cardiac amyloidosis (CA). However, discerning which LGE patterns in amyloidosis distinguish it from other cardiomyopathies remains unclear. This study aims to compare LGE characteristics in a predominantly African American cohort who underwent endomyocardial biopsies. Despite advancements in cardiac imaging techniques, the endomyocardial biopsy remains the gold standard for amyloidosis diagnosis. Insights garnered from this analysis could enhance diagnostic precision and facilitate earlier detection. Methods: In this retrospective study at MedStar Union Memorial Hospital in Baltimore, MD, patients who underwent both endomyocardial biopsy and CMR were included. The study compared individuals with biopsy-proven amyloidosis (both AL and ATTR) to those with negative biopsy results. LGE patterns were selected based on their frequent use in CMR interpretation. Statistical analysis employed Pearson chi-square and t-tests. Results: The cohort comprised 42 patients who underwent biopsy, with 13 patients (31%) with positive biopsy results. Among them, 24 were men (57%), and 81% identified as African American. Demographic, anthropomorphic, and objective clinical findings are detailed in Table 1. The average age of the cohort was 68 years, with those with biopsy-proven amyloidosis significantly older (75 vs. 61 years, p = 0.002). Although the biopsy-positive group exhibited a lower absolute NT-pro-BNP, the difference was not statistically significant. The most prevalent LGE patterns among the biopsy-positive group were diffuse (62%) and basal (31%). Notably, 69% of biopsy-positive patients exhibited an LGE pattern described as infiltrative. However, 38% of the biopsy-negative group also manifested infiltrative patterns on LGE, a difference not statistically significant compared to the biopsy-positive group. The positive predictive value of an infiltrative LGE pattern was low (45%). Conclusion: This study compares CMR LGE patterns in biopsy proven CA. Despite findings of an infiltrative LGE pattern on CMR, when using endomyocardial biopsy as the gold standard, the positive predictive value of LGE in differentiating CA patients was low. Further research and larger studies are warranted to explore additional imaging modalities or biomarkers that may complement or refine the diagnostic algorithm for CA.

A Phase 2 Sensitivity and Selectivity Study of High-Dose 5-Aminolevulinic Acid in Adult Patients Undergoing Resection of a Newly Diagnosed or Recurrent Glioblastoma

BACKGROUND AND OBJECTIVES: The utility of oral 5-aminolevulinic acid (5-ALA)/protoporphyrin fluorescence for the resection of high-grade gliomas is well documented, but the problem of false-negative observations remains. This study compares high-grade glioma visualization with low/standard dose 5-ALA (<30 mg/kg) to high-dose 5-ALA (>40 mg/kg) to see if by using this higher dose, it is possible to reduce the rate of false-negative observations without increasing the rate of false-positive (FP) observations and therefore increase the sensitivity. METHODS: This is a prospective study of consecutive patients with radiological evidence of presumed high-grade glioma. We reviewed the data from patients who received preoperative low/standard doses and patients who received a preoperative high dose of 5-ALA. Adverse events, dose to observation time, intensity of tumor fluorescence, and results of biopsies in areas of tumor and tumor bed under deep blue light were recorded. RESULTS: A total of 22 patients with high-grade glioma received a dose >40 mg/kg (high-dose) and 9 patients received <30 mg/kg (low/standard dose). There were no serious adverse events related to 5-ALA in any subject. There was a very high sensitivity and specificity of 5-ALA for the presence of tumor in both groups. There were no FP observations (fluorescence with no tumor) in either group. The specificity and the positive predictive value were 100% in both groups. The sensitivity and the negative predictive value were 53.3% and 30.0% in the low/standard dose group and 59.5% and 31.8% in the high-dose group, respectively. CONCLUSION: High-dose oral 5-aminolevulinic/protoporphyrin fluorescence is a safe and effective aid to the intraoperative detection of high-grade gliomas with high sensitivity and specificity. False-negative observations with a high dose do not seem to be less than that with a low/standard dose. The rate of FP observations with both groups remains very low.

Sequential Diagnostic Approach Using FIB-4 and ELF for Predicting Advanced Fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease

Background and Aims: Multiple non-invasive tests (NITs) for identifying advanced fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) are available, but, due to the limitations of single NITs, the American Association for the Study of Liver Disease (AASLD) guidelines suggest a two-step strategy, combining the Fibrosis-4 Index (FIB-4) score with the Enhanced Liver Fibrosis (ELF) test to improve diagnostic accuracy and minimize unnecessary liver biopsies. However, few real-world studies have used such a sequential approach. We here evaluated the diagnostic accuracy of the ELF test in patients with recently established metabolic dysfunction-associated steatotic liver disease (MASLD) and assessed the clinical utility of applying a two-step strategy, including the ELF test following the FIB-4 score assessment, in patients with MASLD. Methods: We enrolled 153 patients diagnosed with MASLD who underwent liver biopsy at the Dong-A University Hospital between June 2018 and August 2023. The degree of fibrosis was determined based on liver biopsy results. Various NITs were used, including the Aminotransferase-to-Platelet Ratio Index (APRI), FIB-4 score, NAFLD Fibrosis score (NFS) and ELF test. The diagnostic efficacy of these NITs was evaluated based on the area under the receiver operating characteristic curve (AUROC). Additionally, the performance of each test was further examined both when applied individually and in a two-step approach, where FIB-4 was used followed by ELF testing. Key metrics such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were used for this analysis. Results: Overall, 153 patients with MASLD (mean age: 46.62 years; 52.3% men; 28.1% with type 2 diabetes) were included. The performance of the NITs in identifying advanced fibrosis was as follows: the AUROC of the APRI, FIB-4, NFS, and ELF tests were 0.803 (95% confidence interval (CI), 0.713–0.863), 0.769 (95% CI, 0.694–0.833), 0.699 (95% CI, 0.528–0.796), and 0.829 (95% CI, 0.760–0.885), respectively. The combination of the FIB-4 score ≥ 1.30 and the ELF score ≥ 9.8 showed 67.86% sensitivity, 90.40% specificity, a PPV of 75.18%, an NPV of 86.78%, an accuracy of 83.64%, and an AUROC of 0.791 for predicting the diagnosis of advanced fibrosis. This approach excluded 28 patients (71.8%) from unnecessary liver biopsies. Conclusions: Our study demonstrated that ELF testing maintained diagnostic accuracy in assessing liver fibrosis in patients with MASLD in real-world practice. This test was used as a second step in the evaluation, reducing clinically unnecessary invasive liver biopsies and referrals to tertiary institutions. This approach allows assessment of MASLD severity in primary care settings without requiring additional equipment.

EPID-13. PREDICTORS OF HISTOPATHOLOGIC RESULTS OF BRAIN BIOPSY IN PATIENTS SUSPECTED OF SECONDARY CNS LYMPHOMA

Abstract Patients suspected of secondary CNS lymphoma (SCNSL) often undergo brain biopsies. Recent studies doubt biopsy utility due to high SCNSL diagnosis rates. We sought to enumerate histopathologic biopsy results in suspected SCNSL patients to evaluate utility of biopsy. We furthermore assess clinical and radiographic factors based on ability to distinguishing SCNSL from non-SCNSL. 109 patients with non-CNS lymphoma who subsequently presented with brain lesions that underwent biopsy at MD Anderson Cancer Center were included. Histopathologic diagnoses were obtained. Pre-operative imaging was assessed for contemporary radiologic diagnoses by obtaining the leading differential reported at the time of the study. Subsequently, a staff neuroradiologist, blinded to biopsy outcomes and clinical considerations, provided a retrospective diagnosis. 61 patients had SCNSL whereas 48 did not. Non-SCNSL biopsy results included infection (n=16, 33%), glioma (n=12, 25%), nonspecific (n=12, 25%), and other metastases (n=3, 6%). Patients with non-indolent lymphoma (DLBCL, mantle cell, Burkitt’s, and lymphoblastic lymphoma) were more likely to have SCNSL on biopsy (p<0.001, OR 12.55). Patients with SCNSL had shorter time interval since initial diagnosis (median 18.1mo vs. 63.2mo, p=0.008). Systemic progression of disease at biopsy was not associated with SCNSL (p=0.35). There was no difference in age, stage, LDH, Albumin, ECOG, IPI, anatomic location, or B-symptoms at times of diagnosis or neurosurgery. No patient had positive CSF cytology prior to biopsy. Neither retrospective nor contemporary radiographic diagnoses had sufficient accuracy to replace biopsy. A positive retrospective diagnosis trended towards association with SCNSL pathology (sensitivity=0.94, specificity=0.23, PPV=0.65, NPV=0.70, p=0.08). A positive contemporary diagnosis was associated with SCNSL pathology (sensitivity=0.67, specificity=0.73, PPV=0.76, NPV=0.64, p<0.001). Similar biopsy proportions yielded SCNSL and non-SCNSL. Although some factors are associated with SCNSL, none can reliably distinguish patients. Given the divergent treatments for the reported pathologies, our study reiterates the necessity of biopsy in suspected SCNSL.

Nontechnical Factors and Postprocedural Considerations for Image-guided Breast Biopsy.

Beyond the technical aspects, success and long-term patient outcomes of image-guided breast biopsies depend on the overall patient experience. Patient experience in turn is influenced by intangible factors, such as environmental features during the procedure; patient-centered communication prior to, during, and subsequent to the procedure; and management of expectations and biopsy complications. Here, we review evidence-based literature and results of a national Society of Breast Imaging survey on approaches to both mitigate and manage common image-guided core biopsy complications as well as nontechnical strategies to improve the patient biopsy experience.

Prostate-specific antigen, digital rectal examination, and prostate cancer detection: A study based on more than 7000 transrectal ultrasound-guided prostate biopsies in Ghana

Purpose of the studyThis study aims to determine the role of serum prostate-specific antigen (PSA) levels and digital rectal examination (DRE) in predicting the histological outcomes of prostate biopsies by analyzing a database of over 7000 patients who underwent transrectal ultrasound (TRUS)-guided prostate biopsies. MethodsWe conducted a retrospective analysis of men who underwent TRUS-guided prostate biopsies at Korle Bu Teaching Hospital, a tertiary referral center in Accra, Ghana, from July 2005 to December 2022. The biopsies, which included 10 to 12 core samples, were prompted by PSA levels greater than 4.0 ng/mL, abnormal DRE findings, or both. We then correlated histopathology results with PSA and DRE findings. ResultsOut of 7,338 patients who presented for biopsy, 76.3% were between the ages of 60 and 79. Histology reports were available for 5,289 patients, of whom 2,564 (48.5%) were diagnosed with prostate cancer. Cancer detection rates based on PSA levels were as follows: 21.6% for PSA <4 ng/mL, 21.7% for PSA 4-10 ng/mL, 32.7% for PSA 10-20 ng/mL, 53.0% for PSA 20-50 ng/mL, 71.5% for PSA 50-100 ng/mL, and 92.0% for PSA >100 ng/mL. When DRE findings were classified according to the 2016 TNM System (AJCC 8th Edition) as T1, T2, T3, and T4, cancer detection rates were 26.8%, 51.8%, 87.6%, and 95.7%, respectively. The overall cancer detection rate was significantly higher with abnormal DRE findings (64.6% vs. 26.7%, p < 0.001). Additionally, 78.2% of the detected cancers were high-grade (Gleason score of 7 or more). ConclusionThis extensive study of Ghanaian men undergoing TRUS biopsies reveals a high prostate cancer detection rate, with nearly 80% of the detected cancers being high-grade. These findings underscore the importance of PSA and DRE in the early detection of prostate cancer and should be considered in patient counseling and discussions regarding the implementation of prostate cancer screening programs in this population.

Towards optimized biopsy use in vertebral compression fractures: integrating risk assessment for better clinical decision-making.

Tissue biopsy is the gold standard for differentiating osteoporotic vertebral compression fractures from malignant lesions. However, the necessity of routine biopsies during percutaneous vertebroplasty and kyphoplasty is debated due to the low malignancy detection rates. This study aims to identify key predictors of positive biopsy outcomes in patients undergoing these procedures, with the goal of refining biopsy selection criteria to enhance diagnostic yield and improve clinical decision-making. We conducted a retrospective cohort study involving 295 patients who underwent percutaneous vertebroplasty and kyphoplasty with biopsy between June and December 2023. Clinical data, including age, gender, fracture aetiology, imaging findings, and biopsy results, were collected. Binary logistic regression analysis was employed to identify significant predictors of positive biopsy outcomes. The biopsy results revealed an overall malignancy rate of 1.01% (3/295). Among the 17 cases with abnormal (positive) biopsy findings, 17.6% were malignant, while the remainder were benign. Significant predictors included age (OR = 0.936), gender (OR = 0.307 for males), fracture aetiology (OR = 5.300 for fractures with no apparent cause), and imaging abnormalities (OR = 8.388). This study underscores the low malignancy detection rate in routine biopsies for vertebral compression fractures, advocating for a more selective approach by reserving biopsies for patients with specific high-risk factors. A targeted biopsy strategy, informed by enhanced pre-operative screening, could improve diagnostic accuracy and treatment outcomes, optimizing clinical management.

OA02 Blood, Sweat and Steroids

Abstract Introduction This 79 year old gentleman was referred to the Rheumatology department with arthralgia, myalgia, erythema nodosum, an ESR elevated at 106 mm/h and IgA 6.45 g/L. His GP commenced him on 30 mg Prednisolone once a day for one week. His symptoms and signs improved significantly with treatment, prior to his first Rheumatology review. Case description He initially presented to his GP with pain and a skin rash in his groin which was thought to be fungal and treated as such. He then developed erythematous tender lumps on his right proximal forearm and left hand which were in keeping with erythema nodosum. He had a background history of ischaemic heart disease, hypertension, hyperlipidaemia, squamous cell carcinoma and an elevated BMI. Once the initial course of prednisolone stopped he experienced recurrence of the skin rash, in addition to night sweats, dizziness and weight loss. Inflammatory markers rose. CT scan of chest, abdomen and pelvis, done to exclude malignancy, was normal. PET CT while off steroid showed uptake in the descending aorta, not in keeping with large vessel vasculitis, and generalised bone marrow uptake consistent with an inflammatory process. Prednisolone was re-commenced. Bloods including HIV, Hepatitis, B12, CMV, EBV, Syphilis, ANA, ANCA and Cryoglobulins were normal. Skin biopsy showed non-specific inflammatory change. Bone marrow biopsy showed myeloid hyperplasia and haemophagocytosis. He required two further inpatient admissions due to shortness of breath, anaemia and skin rash, which coincided with steroid reduction. He responded to an increased dose of steroid and antibiotics. Genetic testing then identified a gene for UBA1, a pathogenic variant causing VEXAS syndrome. Clinical features were in keeping – skin lesions, sweats, elevated inflammatory markers, macrocytic anaemia and steroid responsivity. He was commenced on Tocilizumab and responded well. Bloods normalised and prednisolone was weaned. Neutropenia resulted in stopping Tocilizumab and later Anakinra and Sarilumab. Half dose once monthly Tocilizumab and low dose steroid are now successfully treating his disease. Discussion This gentleman had symptoms and signs in keeping with an auto-inflammatory condition. However, it took a number of specialties to investigate him due to blood results and imaging not naturally leading to a diagnosis. Initial differentials included sarcoid and polyarteritis nodosa. The chest and joints were not involved, serum ACE, calcium and CT Angio were normal so these were excluded. PET CT was done to ensure this was not an atypical large vessel vasculitis and the abnormal bone marrow uptake led us to discuss with haematology. At that time he had a pancytopenia with poor reticulocyte response and so haematology carried out a bone marrow biopsy. The bone marrow biopsy result showed a myeloid shift felt to be reactive and there was a degree of haemophagocytosis but he did not meet diagnostic criteria for haemophagocytic lymphohistiocytosis. Still’s disease was queried but he was not pyrexic, there was no arthritis, no hepatomegaly or splenomegaly and there was neutropenia rather than a neutrophilia. Skin biopsy, while not diagnostic, did query a vasculitic process. Therefore it was decided, despite persisting diagnostic uncertainty that he should be treated with Tocilizumb, which did allow steroid reduction. Eventually genetic testing was sent looking for periodic fevers and that is when the UBA1 gene was identified and the diagnosis of VEXAS syndrome made. Subcutaneous Tocilizumab did cause leucopenia and he suffered from recurrent infections. He had also been trialled on Anakinra and Sarilumab but both of these caused neutropenia. We have been able to switch to intravenous Tocilizumab in order to titrate the dose, and he is now on a small dose of 2 mg/kg 4 weekly which has allowed inflammation to settle without causing a drop in white cell count. Key learning points • There is little guidance on treatment of VEXAS syndrome. This gentleman has been difficult to treat due to drug side effects, and so this case raises the issue of few treatment options in VEXAS. It seems little is known about the disease and so we quickly come to a treatment conundrum when side effects prohibit the use of standard therapies. More research is required in to this condition and its management. • This case also raises the importance of working closely with other specialties. Where there is multi-system involvement, multi-disciplinary working is invaluable. It brings other perspectives and breadth of knowledge to the case, increasing the likelihood of making the correct diagnosis. • This case also reminds us of the value of genetic testing. Where it seems there is an inflammatory syndrome but results don’t seem to add up, we should put our patients forward for testing. • At the BSR case based conference I would like to hear other cases of treating VEXAS and what difficulties and wisdom my colleagues have to share. I would also like to hear if there are other treatment strategies others are aware of.

A Case of a 65-year-old woman with Vitiligo and Diabetes Presenting with Severe Autoimmune Hepatitis

Autoimmune hepatitis (AIH) is a chronic liver disease with diverse clinical presentations and significant global variation in prevalence. AIH predominantly affects females and commonly manifests with nonspecific symptoms such as fatigue and malaise, often accompanied by extrahepatic autoimmune disorders. Here, we present the case of a 65-year-old Hispanic woman with vitiligo, type II diabetes mellitus, and severe AIH. Despite extensive diagnostic workup, including serological testing, the cause of this patient’s hepatitis proved to be a challenge. Eventually, autoimmune testing revealed positive anti-smooth muscle antibodies and an elevated IgG, prompting percutaneous liver biopsy, which confirmed mild to moderate active hepatitis with mixed inflammatory infiltrate. Despite there not being a standardized diagnostic criterion for autoimmune hepatitis, the interdisciplinary hospital team agreed that the most likely diagnosis was autoimmune hepatitis, given her constellation of symptoms, serologic testing, and liver biopsy results. Treatment with prednisone was initiated, leading to clinical improvement. This case underscores the importance of a thorough diagnostic workup in suspected AIH cases, especially in patients with concomitant autoimmune conditions, to facilitate timely management and improve patient outcomes. It also highlights the need for a consensus among diagnostic criteria for autoimmune hepatitis.

Lupus anticoagulant-hypoprothrombinemia syndrome with lupus nephritis in a girl misdiagnosed with immunoglobulin A nephropathy: a case report

Distinguishing lupus nephritis (LN) from other glomerulopathies, such as immunoglobulin A nephropathy (IgAN), poses a diagnostic challenge owing to overlapping clinical and histopathologic findings. Lupus anticoagulant-hypoprothrombinemia syndrome (LAHPS) is a rare and potentially fatal disorder characterized by the presence of lupus anticoagulant and acquired factor II deficiency. We report a pediatric case of LN with LAHPS, which was initially diagnosed as IgAN. An 8-year-old girl presented with gross hematuria with nephrotic syndrome. Based on the kidney biopsy results, treatment for IgAN with membranoproliferative pattern was initiated. Two months later, she developed left upper extremity swelling with multiple vein thromboses requiring anticoagulation; treatment led to remission, allowing discontinuation of immunosuppressants within 8 months. Gross hematuria recurred 10 months later and was accompanied by hypocomplementemia; positive antinuclear, anti-double stranded DNA, and triple antiphospholipid antibodies; and factor II deficiency, prompting revision of the diagnosis to LN and LAHPS. Initial delay in LN diagnosis was attributed to the patient’s young age, nonspecific symptoms, and inconclusive laboratory and histopathological findings. Immunosuppressive therapy for IgAN partially improved LN, further complicating the diagnosis. This case emphasized the importance of clinical suspicion; integrating clinical, serological, and histopathological data; and considering LAHPS in differential diagnosis of glomerulonephritis with coagulopathy.

The capture of circulating tumor cells by Labyrinth system as a tool for early stage lung cancer detection

ObjectivesWe focus on utilizing the Labyrinth system for the detection of circulating tumor cells (CTCs) in patients with lung nodules. Our aim is to evaluate CTCs isolated through the Labyrinth system as a biomarker for early-stage lung cancer (LC) detection.Methods167 patients with low dose computed tomography (LDCT) diagnostic results for lung nodules and 31 healthy volunteers (HV) were enrolled. Blood samples were processed for CTC detection. LDCT positive (LDCT+) patients underwent surgery and were categorized into those with LC and those with benign lung diseases (BLD) based on their biopsy results. BLD Patients, LDCT negative (LDCT-) patients and HV served as controls. The correlation of CTC counts with LC, BLD, LDCT- and HV was investigated. Receiver operating characteristic (ROC) curves were used to assess the Labyrinth system’s diagnostic potential for early-stage LC.ResultsMedian CTC counts for LC, BLD, LDCT- and HV were 2.7 CTC/mL, 0.6 CTC/mL, 0.4 CTC/mL, 0 CTC/mL, respectively. Statistical analysis indicated CTC counts could distinguish LC from BLD, LDCT- and HV (p-Values &amp;lt; 0.001). Using a cut-off of 1 CTC/mL, the study showed 84.4% sensitivity and 82.4% specificity for LDCT+ patients. Specificity increased to 85.9% for patients with lung nodules and 88.2% for all participants. In conclusion, CTCs detected by the Labyrinth system can serve as a biomarker for early-stage LC detection for patients with lung nodules.ConclusionsCTCs identified by the Labyrinth system are a promising biomarker for early-stage LC detection in clinical practice.

Performance of an Oral Rinse Point-Of-Care Assay to aid in the diagnosis of Head and Neck Squamous Cell Carcinoma (HNSCC) in a High-Risk Danish Ear-Nose Throat (ENT) Clinic

Abstract Objectives Oral examination and biopsy are established methods for early detection of oral/oropharyngeal squamous cell carcinoma (OOSCC). The aim of the current study was to evaluate performance of a point-of-care (POC) assay to aid in the diagnosis of head and neck cancer. Materials and methods 150 consecutive patients were enrolled from a high-risk ear nose and throat clinic at the Rigshospitalet in Copenhagen, Denmark. A positive POC test represented as a CD44 band or elevated level of total protein (TP) was correlated with biopsy results and then evaluated with sensitivity (Se), specificity (Sp), PPV, NPV and multivariate models. Results 119 patients enrolled between January 2016 and April 2017. Presence of a CD44 band or TP ≥3: Se of 73% (95% CI 57.0–84.6%), Sp of 50% (95% CI 39.4–60.5%), and NPV of 94.77% (95% CI 84.12–98.33%). CD44 band or TP of ≥ 2 for non-smkers and ≥ 3 for smokers improved performance: Se 81% (95%CI 66–90%) and Sp 33% (95%CI 24–44%), NPV of 94%. Multivariate models with male gender and ≥ 60 years: Se of 84% (95%CI 67–92%) and Sp of 37% (95%CI 27–47%), NPV of 95%. Non-biopsied, healthy, non-smoking, females (n = 17): Sp of 78%. Conclusions POC assay performed well for identifying OOSCC in a prospective clinical trial. Clinical features such as age, smoking status and gender are important variables in assessing risk. Additional studies are underway to further confirm these results including the incorporation of a version 2 POC device.

Oncological Outcomes of Partial Gland Ablation Using High-Intensity Focused Ultrasound After Additional Confirmatory Transperineal Mapping Biopsy in Men with Prostate Cancer

Background/Objectives: To evaluate whether additional confirmatory transperineal mapping biopsy (TPMB) in men with localized prostate cancer (PCa) alters the treatment plan and outcome of partial gland ablation (PGA) using high-intensity focused ultrasound (HIFU). Methods: We retrospectively reviewed data from 96 patients who underwent PGA using HIFU between January 2020 and June 2022. After multiparametric magnetic resonance imaging (mpMRI), all men underwent transrectal ultrasound (TRUS)-guided, cognitive-targeted biopsy and systematic biopsy. Men eligible for PGA using HIFU first underwent confirmatory TPMB. Any changes in the treatment plan after TPMB were analyzed. Follow-up TRUS-guided biopsy was performed 1 year post-operatively to evaluate oncological outcomes. Clinically significant PCa (csPCa) was defined as Gleason grade (GG) ≥ 2. Results: Among all subjects, the median age (IQR) was 65.0 (60.0–72.0) years and the prostate-specific antigen level was 5.20 (3.71–7.81) ng/mL. The results of both TRUS-guided biopsy and TPMB led to a change in the treatment plan (from unilateral to bilateral PGA) for 13 (13.5%) patients. The 1-year follow-up TRUS-guided biopsy identified PCa in 13 (13.5%) patients, and csPCa in 7 (7.3%) patients. The infield- and outfield-positive rates were 8.3% (8/96) and 3.1% (3/96), respectively, for any PCa, and 3.1% (3/96) and 2.1% (2/96), respectively, for csPCa. Conclusions: Confirmatory TPMB results in better disease identification and localization, thereby affecting the treatment plan and improving oncological outcomes. Therefore, confirmatory TPMB should be considered to establish an appropriate strategy for patients with localized PCa eligible for PGA using HIFU.

Diagnostic Value of Contrast-Enhanced Ultrasound in Differentiating Malignant from Benign Small Renal Masses After CT/MRI

Background: The aim of this study was to assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) in characterizing small renal masses (SRMs) measuring less than 3 cm and in distinguishing between malignant and benign SRMs. Methods: A retrospective study was conducted between January 2022 and January 2023 at the Radiology Department of (Anonymized data), with a total of 43 patients assessed via CT and MRI scans, which were subsequently studied by experienced radiologists who were blinded to the pathology results. The CEUS findings were then compared with histopathological examination outcomes or follow-up imaging results. Results: The study results revealed a notably high level of diagnostic accuracy, with sensitivity at 0.875, specificity at 0.94, positive predictive value at 0.95, and negative predictive value at 0.86 for characterizing SRMs. Spearman rank correlation analysis substantiated a robust positive linear correlation between the CEUS findings and biopsy results (r = 0.972). Conclusions: These findings underscore the potential utility of CEUS as a valuable tool for discriminating between malignant and benign SRMs, carrying significant implications for clinical decision-making and leading to improved patient outcomes. However, larger validation studies are imperative to establish its role in routine clinical practice and to address potential limitations.

Contrast-enhanced ultrasound combined with percutaneous ultrasound-guide core needle biopsies in the diagnosis of pancreatic lesions: a propensity score-matched study

ObjectiveTo compare the diagnostic performance of pancreatic lesions using percutaneous ultrasound (US)-guided core needle biopsy (CNB) with and without contrast-enhanced ultrasound (CEUS).MethodThe patients were divided into two groups, US and CEUS group, based on whether CEUS was performed prior to biopsy. Before and after propensity score matching (PSM), the CNB-relevant characteristics of the two groups, including the first puncture success rate, the number of sampling, complication rate, type of complications, and degree of abdominal pain, were compared. The accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of percutaneous US-guided CNB were compared between the groups.ResultsThis study included 277 patients (173 men and 104 women) with pancreatic lesions who underwent percutaneous CNB before PSM; 190 patients in the CEUS group, and 87 in the US group prior to CNB. After controlling for potential biases using PSM, no significant differences were observed in the complication rate, type of complications, or degree of abdominal pain between the CEUS and US groups (P > 0.05). However, significant differences were observed in the first puncture success rate and the number of sampling (P < 0.05). Importantly, before and after PSM, the CEUS group achieved a higher first-puncture success rate while obtaining a lower number of sampling (P < 0.05). Compared to the US group, the CEUS group demonstrated improved accuracy, sensitivity, specificity, PPV, and NPV of 13.1%, 14.9%, 13.4%, 2.5%, and 38.7%, respectively. Furthermore, the significant difference was observed in the AUC for diagnostic performance between the two groups when compared using DeLong’s test (P = 0.043).ConclusionsPerforming CEUS before percutaneous CNB for pancreatic lesions can help achieve better biopsy results, reduce the number of punctures samples, increase the success rate of biopsies, and avoid the need for repeat biopsies.

Mycophenolate mofetil for the treatment of cicatrizing conjunctivitis secondary to ocular pemphigoid

PurposeTo characterize the use of mycophenolate mofetil (MMF) in a large cohort of patients undergoing treatment for ocular mucous membrane pemphigoid (ocMMP). DesignThis was a retrospective consecutive observational chart review of patients with cicatrizing conjunctivitis associated with pemphigoid (ocMMP) at the University of Texas Southwestern Medical Center in Dallas, TX from 2016 to 2023 who underwent treatment with MMF. MethodsData collection included patient demographics, medical and ocular history, clinical findings, slit lamp photographs, biopsy results, additional testing, disease stage, time on MMF, patient response to treatment, and side effects of treatment. The data was analyzed with logistic regression using IBM SPSS (version 29). The dependent variable was remission status. ResultsA total of 52 patients with cicatrizing conjunctivitis associated with pemphigoid were treated with MMF, of which 37 (71.2 %) patients had biopsy proven disease. Of the cohort, 29 (55.8 %) patients were female and 23 (44.2 %) patients were male. The mean age at initiation of MMF therapy was 65.1 years (range 35–93). The best degree of response achieved by each patient in our cohort was as follows: no response (4, 7.7 %), partial response (28, 53.8 %), clinical remission with steroids (4, 7.7 %), steroid-free remission (14, 26.9 %), and durable drug-free remission (2, 3.8 %). The mean time of treatment with MMF was 35.5 months (range 2–118), with a mean follow up time of 42.7 months (range 3–123). The mean time to clinical remission was 6.7 months (range 1–18), while the mean time to steroid-free remission was 7.2 months (range 2–18). Of the entire cohort, 16 (30.8 %) patients reported side effects. The most common side effect was nausea (7 patients). There was one adverse event (anemia, 1, 1.9 %). Overall, 30 (57.7 %) patients discontinued MMF, most commonly due to side effects (11 patients) or inadequate disease control (11 patients). ConclusionMycophenolate mofetil (MMF) can be beneficial in ocMMP as a steroid-sparing alternative. Although effective, side effects and discontinuation of treatment were common.

From photonic technologies to microfluidics-A review on the techniques which revolutionize liquid biopsy, opening a new era in cancer therapy.

Cancer therapy is one of the most researched upon medical field in the world. Non invasive technologies such as liquid biopsy are gaining more importance in cancer therapy because of their manifold advantages over traditional invasive biopsy methods. Liquid biopsy is used to analyze nucleic acids such as ctDNA, cfDNA and RNA, cellular and subcellular components such as proteins, extracellular vesicles and circulating tumor cells in various biological fluids such as blood, urine, cerebrospinal fluid, pleural fluid and ascites fluid for diagnosis of cancer. Liquid biopsy has a wide range of applications such as assessment of residual diseases and tumors which cannot be biopsied easily and prediction of CAR-T response and response to immune checkpoint inhibitors. It can also be used to know the efficacy of cancer drugs in a patient by analyzing multiple samples. Liquid biopsy is becoming more popular as it allows biopsy of those samples in which solid tumor biopsies are challenging or impracticable. To achieve comprehensive insight on the status of cancer in a patient, various cutting edge liquid biopsy techniques have been developed. Microfluidics and photonic technologies, along with PCR, next generation sequencing, advanced and innovative molecular and cell biology approaches and imaging techniques have expanded the domain of liquid biopsy and elevated the accuracy of liquid biopsy results. This review discusses about the contributions of some widely used methods along with microfluidics and photonic technologies in detection of cancer biomarkers by liquid biopsy.

Clinical effect of secondary LEEP combined with transcervical resection of endocervical tissue for cervical precancerous lesions with positive internal margin after the first LEEP

Objective: To preliminarily investigate the clinical outcomes of secondary loop electrosurgical excision procedure (LEEP) combined with transcervical resection of endocervical tissue (i.e., second combined surgeries) in patients with positive endocervical margins following the initial LEEP for high-grade squamous intraepithelial lesion (HSIL) or adenocarcinoma in situ (AIS) of the cervix. Methods: Patients who underwent second combined surgeries due to positive endocervical margins after the initial LEEP for cervical HSIL or AIS at Obstetrics and Gynecology Hospital, Fudan University between August 2015 and September 2023 were included. Postoperative cytological examinations, high-risk human papillomavirus (HR-HPV) testing, colposcopic biopsy results, and cervical canal length were followed up to evaluate the clinical efficacy of second combined surgeries. Results: (1) General clinical data: a total of 67 patients were enrolled, including 34 with cervical HSIL (HSIL group) and 33 with AIS (AIS group). In the HSIL group before the time of initial LEEP, the mean age was (41.3±5.3) years, with all patients positive for HR-HPV preoperatively. Preoperative cytology results revealed ≤low-grade squamous intraepithelial lesion (LSIL) in 13 cases and ≥HSIL in 21 cases. The preoperative cervical canal length was (3.71±0.17) cm. Patients in the AIS group before their the first LEEP were at an average age of (39.1±8.7) years old, with preoperative HR-HPV positive. Among them, 16 cases showed preoperative cytological results of ≤LSIL, while 17 cases showed ≥HSIL. The preoperative cervical canal length was (3.64±0.21) cm. (2) Pathological findings and postoperative follow-up of the HSIL group following second combined surgeries:in the HSIL group, the residual rate of HSIL in the endocervical canal tissue (ECT) was 24% (8/34). Out of the 34 HSIL patients, 10 cases (29%, 10/34) remained with positive endocervical margins post-second combined surgeries. Among these 10 patients, 5 cases (5/10) had no lesion detected in ECT, while the remaining 5 cases (5/10) exhibited HSIL in their ECT. Conversely, 24 patients (71%, 24/34) had negative endocervical margins after second combined surgeries. Of these 24 patients, 3 cases (12%, 3/24) were found to have HSIL in ECT, and 21 cases (88%, 21/24) had no lesion in ECT. During follow-ups conducted at 6 and 12 months post-second combined surgeries, the clearance rates of HR-HPV were 91% (31/34) and 100% (34/34), respectively. Notably, among the 29 patients (85%, 29/34) who were followed up for a period of 2 years or longer, all cases maintained a consistently negative HR-HPV status, highlighting the effectiveness of second combined surgeries in achieving long-term HR-HPV clearance (100%, 29/29). (3) Pathological findings and postoperative follow-up of the AIS group following second combined surgeries: the residual rate of AIS in the ECT following second combined surgeries among AIS patients was 15% (5/33). Out of the 33 AIS patients, 11 cases (33%, 11/33) had positive endocervical margins post-operation, among whom AIS was detected in the ECT of 2 cases (2/11), while 1 case (1/11) was diagnosed with adenocarcinoma in the cervical canal tissue (subsequently underwent radical surgery and was excluded from this study). In contrast, 22 patients (67%, 22/33) had negative endocervical margins post-operation, with AIS found in the ECT of 2 cases (9%, 2/22) and no lesions detected in the remaining 20 cases (91%, 20/22). Follow-up evaluations conducted at 6 and 12 months postoperatively revealed HR-HPV clearance rates of 91% (29/32) and 97% (31/32), respectively. All 32 (100%, 32/32) AIS patients were followed up for a duration of ≥2 years post-second combined surgeries, during which HR-HPV remained consistently negative. (4) Complications and cervical length following second combined surgeries: neither the HSIL group nor the AIS group experienced significant complications such as hemorrhage, infection or cervical canal adhesion. At the 6-month follow-up, the cervical length of both HSIL and AIS patients exceeded 3 cm. By the 12-month follow-up, the cervical length had recovered to 96.5% and 97.5% when compared to the original length, respectively, for the HSIL and AIS groups. Conclusions: For patients with HSIL or AIS who exhibit positive endocervical margins following the initial LEEP procedure, undergoing second combined surgeries presents as an optimal choice. This surgical intervention guarantees thorough excision of the lesion, and subsequent colposcopic follow-up evaluations consistently demonstrate an absence of residual disease or recurrence. Moreover, it augments the rate of sustained HR-HPV negativity, thereby contributing to more favorable clinical outcomes.

Should a borderline negative HER2 result in a core biopsy of invasive carcinoma of the breast have HER2 assessment repeated in the excision specimen?

AimThe 2015 UK guidelines for HER2 assessment in breast cancer recommended repeat assessment if the core biopsy was scored as 2+ on HER2 immunohistochemistry (IHC) with borderline negative in situ...